Perfect pearlies: The quest for that winning smile

David Kennedy, Contributor, Jakarta, d_kenn@yahoo.com

If the eyes are the windows of the soul, then what is the mouth? There is no denying that a sparkling smile, whether from a used- car salesman, a pop star or a president, has the power to charm and persuade.

Even when it's making no sound, it seems the mouth is communicating.

A recent survey by the American Academy of Cosmetic Dentistry found that 74 percent of Americans believed an unattractive smile could hurt a person's chances of succeeding in their career.

When questioned on body image by the journal Psychology Today, a majority of respondents said that the thing they most wanted to change about themselves was their smile.

"The technology is there and everyone wants to look better," said Dr. Robert Dharma, president of the Indonesian Cosmetic Dentistry Society.

"A famous dentist once said that a good smile can influence the whole physiological appearance and health of a human being. Someone with a very good smile tends to smile a lot and feel better."

Looking good is particularly important for those in the public eye. Celebrities, politicians and businesspeople have traditionally been the main customers of cosmetic dentists.

"I think it is logical for them to be aware of their smiles because it is very important for their career. In fact two thirds of the face is in the field of the dentist," said Dr. Hilly Gayatri, a cosmetic dentist who treats many celebrities and public figures at her practice in South Jakarta.

Celebrities such as singers Krisdyanti and Titi DJ, both patients of Dr. Hilly, have helped to fuel the growth in popularity of cosmetic dentistry.

"If the teeth are not straight or white, the lip will not be sensual. The shape of the lip depends on the arch of the teeth," she said, comparing the mouth to a French can-can dress, the shape of which is supported from inside.

"Orthodontics can put the teeth in a certain position so that the lips look good."

Patients are given a set of options by a cosmetic dentist and, depending on their level of need and commitment, treatments can be short lived or last years. However, celebrities tend to have tight schedules and Dr. Hilly said they often prefer a quick fix and short-term cosmetic treatment.

"Some people want straight teeth just for a wedding or a sinetron (soap opera). This is what we call 'theatrical dentistry'," said Dr. Hilly, explaining the changes are almost instant as the dentist reshapes the teeth by carving them and adding a veneer.

Cosmetic dentistry also involves surgery; dental studios sometimes employ plastic surgeons to adjust gums, lips or protruding chins. The mouth reveals tell-tale signs of aging which can be reduced with a nip and a tuck.

"A certain proportion of your teeth show when you smile," said Dr. Hilly. "When you are around 20 years old, you show about 4 mm (of teeth). At 40 if you show 2 mm, you will still look good. If no teeth show, you will appear old but we can correct it and make the lip shorter with plastic surgery."

Certain aspects of cosmetic dentistry are less cosmetic and based on saving a patient from pain and conserving their teeth as well as on esthetic considerations.

Bert Hurlbut, a 64-year-old expatriate working in the oil business, had two teeth extracted eight years ago and no orthodontic work done at the time. Eventually, his other teeth moved in to fill the gaps and his lower teeth began to wear out as his "bite" changed.

"It was not until I saw a dentist here in Jakarta that I learned what had happened to my teeth. He put in bridges and began to resurface the lower teeth," said Bert, who said he had delayed the treatment due to its high cost until he could not bear to wait any longer.

Although somewhat cheaper than in the United States, his dental care bill will still amount to about US$9,500.

Children are also reluctantly finding themselves in the dentist's chair for esthetic reasons but which also may have more serious repercussions if not dealt with early on.

"Maybe it is evolution or because food is so soft now but children's jaws tend to be narrower than before -- maybe because they are not chewing hard food and thereby building up their jaws. However, their teeth are still the normal size so they are crowding," said Dr. May, a family dentist in Central Jakarta.

Increasing numbers of children aged 11 and 12 years old need wire braces. The latest fashion among both Indonesian and expatriate children, according to Dr. May, is to wear colored elastic on braces and there is a big demand for red and green ones among many children in the run up to Christmas.

Among teenagers and young people more elaborate decorations are also popular.

"Tooth accessories" include dental diamonds which can cost from Rp 150,000 to millions of rupiah, depending on whether or not real diamonds are used. Dental diamonds of the fake variety are glued onto the teeth and cause no damage, while real diamonds require drilling a hole into the teeth.

The fastest growing treatment sought by adults across the globe is bleaching or whitening. Since 1996, demand in the U.S. has risen by over 300 percent and the arrival of home care kits promoted on commercial television channels has also boosted their sales here.

According to cosmetic dentists, there are few risks involved in using reputable brands under the supervision of a dentist though if the substance is left on too long it can leave teeth an unattractive translucent color.

Other advances in recent years include white composite fillings and porcelain crowns which have been replacing the black metal amalgams and driving up demand for cosmetic dental services.

One dentist estimates that almost 50 percent more patients now come for esthetic reasons rather than to avoid pain.

"There is a greater dental consciousness now than say five years ago. It's especially noticeable among young executives who have studied abroad and are aware of all the technology that its available," said Dr. Suryadharma, a dental surgeon in Central Jakarta specializing in high-tech treatments, such as invisible braces.

The range of choices and increased complexity of treatments often prove confusing for patients. Enti, a 26-year-old medical assistant at a health clinic in Jakarta, visited four dentists and received different advice from each regarding teeth straightening.

"At first my dentist in Bali put on braces but did not extract any teeth though I had overcrowding. Then in Jakarta another dentist said that three teeth needed to come out to make room," said Enti, who was advised by yet another dentist to not have any teeth removed.

As with any branch of medicine conflicting opinions may arise. However, Dr.Hilly believes that there is a line that dentist should not cross.

"One well-known announcer on television suddenly appeared with straight teeth and I knew that she'd had four teeth taken out at the front to make a bridge," said Dr. Hilly.

"I felt so bad for her as you don't know what will happen when she is older. She could end up with a flat face. They pulled out the front teeth which support the face between the nose and the lip which means there is less support there."

The current demand for cosmetic dentistry runs the risk of putting the patient's desire for better looks ahead of safety considerations. However, efforts are underway to standardize training in Indonesia with the introduction of a training course developed by New York University for International Dentistry.

According to dentists, every six months new technologies arrive on the market and the demand for new treatments is constantly growing. Cosmetic dentistry is a pioneering field and patients need to be fully informed of the pros and cons of treatment by their dentist.

"Cosmetic dentistry is very new. Usually in dentistry the science comes from the university to the practitioner but in cosmetic dentistry it comes from the practitioner to the university," said Dr. Robert Dharma.